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General NPI Number Information
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NPI Number | 1740272723
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Entity Type | Individual
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Provider Name | BRYAN VYVERBERG M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/17/2005
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 812 CREIGHTON RD
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City | PENSACOLA
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State | FL
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Zip | 32504-7028
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Country | US
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Telephone | 850-564-6644
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Fax | 866-740-0655
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Provider Business Mailing Address
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Address Line | 8845 LORRAINE RD
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City | GULFPORT
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State | MS
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Zip | 39503-5042
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Country | US
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Telephone | 228-277-1771
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Fax | 866-740-0655
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 10017
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 22206
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME169348
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License Number State | FL
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